Open Reduction and Internal Fixation of Radial Head Fractures: Screws or Plates?
Justin Mirza, MD; M Ather Mirza, MD
Massachusetts General Hospital, Boston, MA
Submission: Poster or presentation
Title: Open Reduction and Internal Fixation of Radial Head Fractures: Screws or Plates?
Authors: J. Lans, B. Notermans, Q. van der Vliet, J. Jupiter, N. Chen
Introduction: It is unclear what factors are associated with reoperation after open reduction and internal fixation (ORIF) of radial head and neck fractures. We evaluated what patient-, fracture- and treatment characteristics were associated with reoperation after radial head ORIF.
Material and Methods: We retrospectively identified all patients that underwent primary ORIF of a radial head fracture using Current Procedural Terminology codes. All adult patients that were treated between 2002 and 2015 at a single institutional system were included (n=108). A medical chart review was performed to collect data regarding demographics, fracture- and treatment characteristics along with postoperative complications and indications for reoperation. There were 2 (3.3%) Mason I fractures, 21 (34.4%) Mason II fractures, 23 (37.7%) Mason III fractures and 15 (24.6%) Mason IV fractures. Most of the patients underwent screw fixation (75.9%), 24 of the patients had plate fixation and 2 patients had other types of fixation (Kirschner wire and suture fixation). All explanatory variables with a p-value <0.10 were included in a multivariate logistic regression.
Results: The reoperation rate after radial head ORIF was 22.9% (25 of 109) during a median follow-up of 6.9 months (IQR 2.9 Ð 13.8). After adjusting for fracture type (radial neck fracture versus radial head fracture), plate fixation was found to be an independent predictor for reoperation compared to screw fixation (OR 5.19, 95% CI: 0.093-0.32, p=0.004). Implant irritation was the leading (59.3%) cause for reoperation, followed by restricted motion (30%), heterotopic ossification (14.8%), pain (11.1%) and infection (7.4%).
Conclusion: Although plate fixation may be feasible for radial head fractures, this technique increases the odds of reoperation by 5 compared to screw fixation. When choosing fixation techniques, it may be preferable to perform fixation with only screws when possible.
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